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What Does Health Care Reform Really Mean to American Fatasses? Part One In A Series

I would like to start a dialogue here about the potential impact of the health care reforms being discussed in the United States and what they might mean for fat people. And in the interest of not having one post that goes on for three months that only two people will read (sorry Rachel, I did my best!), I’m breaking it into multi-parts. My readers from outside the U.S., I hope you’ll stick around, because I would very much like your input on this.

I’m getting very concerned that the “our health care system is fine, shut up and quit whining because everyone hates government-run health care” crowd is taking over this discussion, without a whole lot of input from people who have actually experienced government-run health care, in all its myriad forms. It’s not all the same, you know. Even within the same country it’s not all the same. (What a concept, huh?)

Please note that I’m not specifically calling out Sandy here; I am to the left of her on this issue, but JFS is far from the only place I’ve run into anti-universal health care memes. They’re everywhere. Insurance companies are spending barrels of cash — OUR cash, that they’ve raked in through our premiums over the years — to fight any kind of real public option, much less actual single-payer delivery. I personally don’t see single-payer coming to America any time soon (it’s not even on the table right now), so it’s not like they’d be out of business. You’d think they would like to have a system in America similar to that of France or Germany — where, in a nutshell, government-run care covers the basics and various forms of private insurance cover the rest. The insurance companies wouldn’t have to get dinged $200 here and $200 there for dinky-shit things like Pap smears and bringing 5-year-olds to the emergency room after hours to get antibiotics for ear infections. (I’ll be examining the “let them eat emergency rooms” theme in a later post.) And people would still want their policies for when they needed more than basics.

But I suppose insurance companies in France and Germany don’t rake in the billionaire executive and shareholder bonanzas that we have here. One thing I’ve managed to figure out over the years is this: Once people get used to living the high life, they don’t give it up without a fight. And we, as a society, have given them the message over the years that it’s just fine to hang on to all that through any means necessary. If it means they get to pull shit like rescission — canceling people’s policies on technicalities because they’ve become too high maintenance for the insurance company’s taste — hey, it’s all good. If it means people become not just uninsurable but actually unemployable because of a serious illness — feh, who cares about those luz0rs? (I broke my Great Orange Satan boycott to read that story, and it was totally worth it; if you’d rather not give them the clicks, it’s also here. But do read it, and if you still think people being umbilically dependent on their jobs for their health care is a fine thing, tell me why you think something similar couldn’t possibly happen to you, or to whoever carries your policy.)

Is that what people are really being told by the insurance companies and their corporate-media toadies to be afraid of? That the super-rich health-care profiteers will cease to live like kings and have to live like mere TV starlets instead?

What, after all, was that anti-UHC ad that made the rounds the other day — the one where the Canadian woman who’d been down-triaged for surgery for a noncancerous but still dangerous brain cyst and had to come to America to get treated — all about? Now, granted, someone probably fucked up badly triaging her and if so, they deserved to get sacked immediately for their fuckup. (Of course, it’s not like insurance companies in America don’t fuck up things like that every day on purpose, but never mind.)

But that’s not really the issue here. She wasn’t making a comparison between Ontario health care (Canada’s UHC is run by individual provinces) and private American insurance. She didn’t have private American insurance. She plunked down US$100,000 in cash to have that operation done. The kind of money, IOW, that most Americans can’t possibly beg, borrow, or steal, much less just access from their personal checking accounts, to pay for an operation. All her story proves is that if you can whip out a checkbook that’s padded generously enough, you can buy anything you want. That’s not news. Is that what they are telling us to fear, fear, fear — that we won’t be able to play front-cutsies in line by slapping a big wad of cash on some hospital administrator’s desk? It’s hard to imagine an America where personal money will buy no influence over health-care priorities whatsoever, but it’s harder still to imagine an America where nearly everyone who thinks they’re going to be that rich someday actually gets there.

And as for the spectre of rationing, we are already rationing health care in America. We ration based on ability to pay — not as in less wealthy people get less, but as in less wealthy people, especially those between jobs, get NOTHING NOTHING NOTHING (unless they are indigent enough to qualify for Medicaid or their state’s equivalent, and increasingly, not even then). We ration based on preexisting conditions that have become the equivalent of insurance-company cooties-for-life.

Now, given all that, do I think things could be a lot worse? Do I think it’s possible that what passes for health care reform in America could wind up being a total boondoggle, nothing more than a bailout for the insurance companies with no improvement in delivery of care? Do I think it’s possible it could lead to the government sticking its nose in our private lives where it doesn’t belong? Sure. I don’t believe “doing something” is automatically better than doing nothing. You can fuck up anything by underfunding and mismanagement and just plain old greed and corruption, whether the funding is public or private or a mix of both.

And here’s where my non-U.S. correspondents come in. I want you to give it to me straight, even if you think it’s not what I want to read. If you have experience with both U.S. and non-U.S. health care — as Deeleigh talked about here and here, and thanks, Deeleigh — that’s even better. I want you to tell me what you like and don’t like about your health care. I want you to tell me whether you think the relief of financial stress from not having to pay directly for care is offset by the stress of your tax burden and other quality of life measures.

And I want you to tell me if you’ve ever been denied care because you were fat. By that I’m not so much talking about the doctor being a giant dickcheese to you because of your weight, but actually denying you a procedure or other treatment you wanted until you lost X number of pounds (or, heavens forfend, got WLS). If you’d like to post anonymously, that’s fine. I won’t out you. You can also email your responses to me and I can post them without attribution if you would prefer that.

I’d also like to hear from you if you’ve experienced an American-based public health system — Medicare, Medicaid, VA, a state-run system, anything like that — and the same questions apply.

I’m also interested in hearing from health-care professionals everywhere on their specific experiences with this. Have you ever not been able to get a treatment approved for someone that you thought they really needed because of problems with a public provider?

And if this post inspires you to do a post on your own blog instead of posting in comments here, great! Feel free to drop links if they’re relevant to the topic.

Please note: I’m well aware that the discussion on this topic could get a bit heated, and I don’t expect an echo chamber where everyone just nods and agrees with me. I want real information based on real experience (not rumor), and I really, really want us to stick strictly to the exchange of ideas and exploration of issues. I’m telling myself this at least as much as I’m telling any of you reading this, but please let’s all stay away from things like flaming, personal insults, and ad-homs. (I especially do not want this to become a forum for Sandy-bashing, and Sandy, if you’re reading this, I hope you will participate in the discussion.) I work odd hours and sleep during much of the day and can’t be on this thread for much of the day (and if you are a first-time poster and your post doesn’t show up for a few hours, that could be why), but I will edit or remove any inappropriate material as soon as I get to it. Thanks.

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74 Responses to “What Does Health Care Reform Really Mean to American Fatasses? Part One In A Series”

Thank you so much, Meowser, for writing this. I was thinking I needed to write about my own grapplings with this, but you did a brilliant job of laying it all out.
I choose the career I have because I would basically be guaranteed health insurance if I stayed in it, and since I was diagnosed with diabetes at 25, health insurance has been a necessity. Add in Mr. Rounded’s health issues and having a child and I’m basically working in order to be insured at this point.
The idea that an employer might not hire me, or might raise my own health insurance costs if I refuse to or am unable to lose weight really freaks me out. That’s in part why I want universal coverage — so I can have more freedom to have a job I love (my current job isn’t bad), and so that I won’t be held hostage and forced to diet because an employer is trying to reduce health care costs.
I think if people are guaranteed to have health care, the U.S. will have many more entreprenures and happier, more productive employees (and the potential to actually have raises again someday).

I’m Australian (universal healthcare), work in pharmacy, have survived cancer, and am fat. I have had poor treatment because of my weight, but none of that was a structural issue – individual doctors can be assholes anywhere. While they were denying that I was ill, saying I was just fat and lazy, I still could go to the doctor for free as often as I wanted, get anti-depressants for less than $4 a month, get free counselling, and, when I did finally have the appropriate tests, I paid almost nothing. The whole experience, including surgery, medication, over 100 tests (yes, seriously! It was a rare cancer!) cost me less than $250 over 2 years. I was too sick to work at the time and received income support from the government – but this is the standard level of healthcare. There is no Medicaid-type program.

Our system does have problems – the previous government (close friends with the Bush government) chronically underfunded much hospital care, though medications were still properly funded. Healthcare in rural areas is far more difficult to access than in cities. Dental work is not covered by Medicare for most people, and it really should be – it’s a major cause of illness and chronic disadvantage. The system doesn’t always work for people who have a rare condition or who don’t fit in the bureaucratic boxes (e.g. people with both mental and physical illnesses like schizophrenia and diabetes; homeless people with multiple medical issues; Aboriginal people; cancer patients who want subsidised access to new medications right now because they’re dying.) Operations can be delayed for months, and there is a private healthcare system that wealthier people use for backup in these situations.

But unemployed people, sick people, fat people, chronically ill people, disabled people, women, children, the elderly, the mentally ill – we all have equal access to healthcare and heavily subsidised treatment and medications. People aren’t going bankrupt taking care of basic healthcare; a non-fatal car accident won’t destroy your entire family’s finances. Most medications are capped at $32.90/month, $5.30/month if you’re a low income person or pensioner of any sort, including single parents.

Most people pay 3% of their income to provide this care. If you earn over $75000, you pay 5% unless you take out private healthcare (i.e. are paying extra for the care that the insurance company deigns to allow you). But the people on private insurance ALSO have full access to the public system. It’s not an either/or situation.

I’ve lived briefly in England, and dealt with the NHS for routine gyn stuff, ongoing medication (including metformin for PCOS), and injury. I lived most of my life in the U.S. –part of (the adult part of) it insured part of it not. I’ve lived in Germany for the past three years.

So far (in Germany) I haven’t been denied treatment for being fat, although I have been sent for an MRI of my spine because the x-ray technicians at the orthopedist office I was sent to couldn’t get a decent x-ray, but that may have just been part of the general suckiness of that particular doctor’s office.

Here, people who make more than a certain amount per year can opt to go on private insurance instead of public, but that gets expensive if you have kids, because if either parent is on private insurance, the kids have to be private, too. There are different administrator companies for the public insurance with slightly different costs and benefits. But the cost is capped at… I forget, 11% of income? Usually it’s between 9 and 11% IIRC. And that covers your spouse (if he/she is unemployed) and kids at no extra cost. My husband luckily opted for public insurance before we met, because no private insurer would accept me, partially because of pre-existing conditions (hello, PCOS), partly because of family history (practically every woman on all sides of my family has diabetes, fat or thin; there’s rheumatoid arthritis and lupus in there, too), and I suspect partly because of weight, but I don’t know for sure because I’ve never tried for it –both my husband and I are strong believers in supporting the public insurance anyway. (We just wish that people couldn’t opt out!)

Oh, and by law, the employer has to pay part of that 11%. It used to be 50/50 between employer and employee, but it’s switched a little more towards employee now (gee, thanks right-wing government…). Looking at my husband’s latest paycheck, the company is paying 47% of the cost.

Private insurance care is out-of-pocket and then reimbursed. Kasse patients (Kasse is short for Krankenkasse, the public insurance) pay 10 EUR a quarter (to whichever doctor they see first, and then they have to get referrals from that doctor, or they can pay the 10 EUR again to a different doctor), plus 10 EUR a quarter for non-checkup dental care and 10 EUR a quarter if they need emergency services (which I did need once, slipped disks while in a small village in the country on a Sunday –and in Bavaria nothing’s open on Sundays– and a doctor came out to the house from the nearest largish town to see me!)

The Kasse doesn’t generally cover birth control meds. Also, the gynecologists are currently up in arms over a reduction in what they get paid by the Kasse for routine care (again, thanks right-wing government!). And off-label meds aren’t covered (like my metformin for PCOS instead of diabetes) –but 120 pills of metformin 1000mg (that’s six months for me, although the bad endocrinologist was determined that I should be taking two of them a day) costs about EUR 35, when 30 of the same pills –or maybe even smaller ones, it was a while ago– cost me $80 in the U.S. back when I wasn’t insured. My BC pills (currently Diane-35, past yasmin and yasminelle) cost me about 65 EUR for six months –I used to pay $35 a month when my insurance in the states stopped covering them.

Oh, one thing I forgot. You’re generally required to have health insurance. It’s a little more complicated than that, especially for freelancers, but that’s the basics. Although the complications mean that there are some uninsured people in Germany.

I am a US citizen, but I’ve received “free” health care my entire life from the Indian Health Service because I’m Alaska Native and that was one of the things that was negotiated from the US government in exchange for our land. It varies greatly depending on where in the nation you live and how well the individual clinic or hospital manages their funds, but at my current location, the care provided is both top notch and extremely timely. I’ve never been denied service because of my weight or any pre-existing condition.

That isn’t to say it’s always been great. It used to be huge waits to see a doctor you’d never seen before with no continuity of care and questionable follow-up. But since individual tribes have been able to take over management of their funds, we’ve (at least in my area) really changed for the better. I have my own primary care physician who I can see as often as I need to almost always on the same day I need the appointment. Services are coordinated and I’ve never had to wait more than a week for services like ultrasounds or blood work.

I have insurance as well, which I do use because the clinic does not receive enough funding from the federal government to support all its services, but I don’t have to pay for prescriptions, co-pays, or basically any cost beyond what my insurance covers. I am thankful for it every single day. I can’t imagine the horror of having a pre-existing or even newly diagnosed medical condition and having to worry about paying for that or my rent. Or losing coverage because of that.

@Jenny – Aboriginal healthcare in Australia is generally poor, and gets worse the further you get from cities. How is care in the remote communities in Alaska? How are medical staff recruited? I’m not indigenous myself, but I do live in a lightly populated rural area with a sizable indigenous population and have waited more than a week for basic services like ultrasound and non-emergency X-Rays. It’s very difficult to get medical staff and even harder for areas with majority indigenous population (my area is majority white).

Care in remote communities really depends on the regional health organization and how they choose to serve their people in the service area. While most communities don’t have a full-time doctor, they do have community health aides that can deal with general medical problems and consult with physicians using telemedicine technology to decide if the village resident needs to be sent to the regional or state hospital for more care. In the case of emergencies, people are generally flown either to Anchorage or their regional hospital.

Like I said, it very much varies depending upon how the region has chosen to distribute their means. My experience has been very good, even when I lived in a rural region. But I can’t say that is representative.

I’m living in Japan, where everyone is required to buy government health insurance if they haven’t bought it from someone else. How much it costs is determined by your income the previous year, so it was painful the year after I quit my job and went back to school. It is nice that going to the doctor has cost me $10-20 each time I went to the clinic to see if I had a bad cold or influenza. I haven’t had anything serious wrong with me, so I can’t comment on that. I do notice they gave me a ton of pills both times and I think it is because they get paid by how much service they provide, and that includes how many pills they prescribe, so they want to prescribe more pills. One of the doctors told me to make sure I don’t eat too fast, which was kind of suspicious, but other than that I haven’t gotten any fat-shaming when I went in for something else. But I have had mandatory check-ups for work and school, and THOSE doctors always tell me to go the hell on a diet, but in writing, so that I can’t actually respond or anything (not that it is easy to explain the intricacies of FA in Japanese). One of them also told me she wanted to do tests on my heart for something that my regular doctor in the States found totally ridiculous, so I think she was just trying to scam me/my insurance out of money. She also got a ridiculous blood pressure reading (either it was peaking higher than it ever has before or since, or she was incompetent at taking it, or she was trying to scare me thin), and I think I have had white coat syndrome ever since (although I suppose I could have before and not noticed because the doctors never had a problem with my blood pressure).

I’ll second what lilacsigil’s said about the Australian health care system. It’s not perfect by any means, but it’s still pretty good.

Me and my partner have bought private health insurance as it covers extras like dental. But here’s the interesting thing; our insurance company doesn’t exclude me or charge me extra for being fat and having a genetic condition and various chronic illnesses. It doesn’t charge my partner extra for having a knee problem (caused by exercise when he was slimmer) and a current BMI of 31. We didn’t need a medical exam or to provide records when we signed up, and I’m not limited in what doctors I can see or what procedures I can have, etc. And it seems seriously cheap compared to the rates I’ve seen for US insurance companies. We pay $300 a month for the absolute top hospital cover + top extras. A single person can get basic hospital + basic extras for about $35 a week. It is not dependent on our employer, either.

They can have these low rates and inclusive coverage policies because we have Medicare providing for everyone. And I haven’t actually come across any incidents of myself or others being denied care for being fat. I know there was a story at least a year ago where a fat older man in rural Victoria was told he couldn’t have his knee operation in his small-town hospital as they believed the anaesthetic risk was too high for them to manage. But they didn’t want to deny him the operation – they just wanted to do it in a better-equipped hospital. (Whether or not his risk was actually high, I can’t say – not enough detail in the article to see whether they were basing it solely on BMI or on other factors.) I had one ENT specialist tell me I’d have to lose weight to get sinus surgery, but he was just being an ass – I’ve had several procedures with Anaesthesia While Fat and the anaesthesiologists have never had a problem dealing with me or refused to knock me out.

But even without any private insurance, care is still good quality and fairly cheap or free. It’s not like socialised or universal health care suddenly turns all doctors into health fascists, and in the free market doctors are all saints. Reading fathealth.wordpress.com (First, Do No Harm) is pretty good evidence that there are asshat doctors, nurses, and the like EVERYWHERE, no matter the kind of health system. I think it’s disingenuous of those who are anti-UHC or anti-SHC to take alarming examples from some of the more troubled systems like the UK NHS and say that that is exactly what will happen in the USA if a government-funded health system was put in place.

Living in a rural area myself, operations here are often done with a GP anaesthetist, who is not qualified to work with higher risk patients. This includes pregnant women, people with heart conditions or certain breathing-related issues, some fat people and children under 12. These people will be sent to a hospital with a specialist anaesthetist, though I had two minor surgeries with a GP anaesthetist and a BMI that would have been well over 40 at the time, because I wouldn’t be under for very long.

In the US it’s also true that there isn’t always a qualified anesthetist on hand at a rural hospital – i’m from a decent-sized town but I had a coworker who had an emergency c-section with no anesthetic because she was from a very, very small town with a very small hospital.

Exactly! That’s what always pisses me off the most about the anti-universal healthcare crowd; they point out ONE country’s problems and assume that everywhere else it would be the same. I’m really interested in opposing viewpoints, but it’s impossible to find anything that isn’t based on either that or some other unreasonable assumption. Like, for example, that every single person who wants universal healthcare is a socialist.

You can fuck up anything by underfunding and mismanagement and just plain old greed and corruption, whether the funding is public or private or a mix of both.

That’s a very important point. I’ve always been of the opinion that the government makes mistakes for exactly the same reasons as everyone else. Underfunding, mismanagement, greed and corruption? Why yes, those are big problems, and they are certainly not unique to the government.

I’m afraid as someone who has never had a job, and thus has been dependent on financial support of all kinds for her entire life, I can’t answer most of your questions. All I can tell you is that here in Germany, it is possible to be sick and poor without having to starve or to go without healthcare. But if you think about it, that’s what matters the most, isn’t it? It should be possible. Everywhere.

I am an American but lived in the UK and was on the NHS for five years.

The differences are dramatic. Last year, before moving back to Seattle, I sprained my neck (in the utterly non-embarrassing process of *adjusting my pillow in bed*). It was horrendously painful. I waited in A&E for maybe 45 minutes, was seen, given drugs, and went home…without paying a penny.

Almost exactly a year later, this January, I went to an ER here in Seattle because my throat was swelling up. I waited approximately the same length of time, was treated efficiently (oh, and a billing person came and saw me, something I didn’t have to do in the UK), and walked away with a bill of nearly $500 for, presumably, heated blankets, the only thing that was different from A&E in Manchester. For three tablets alone (a steroid pill and two allergy pills), I was charged $11.

In Manchester, I’d go again in a heartbeat if my throat were swelling (it was deemed an allergy attack to some unknown allergen). A few weeks ago here in Seattle, my throat started swelling again and I just took an allergy tablet and hoped it would pass. Luckily it did, because I sure as heck was not going to go to the ER (for another $500) unless I passed out in my office.

I also had a small metal shaving removed from my eye while I was in Manchester…oh, and had full antenatal care (including blood sugar monitoring because of PCOS, and monthly ultrasounds to check my baby’s growth because I’m hypothyroid)…all for free. Prescriptions were free to me because I have a permanent health condition (hypothyroidism) and any treatment for my child is free until he turns 18.

I’m sorry but these constant co-pays and the massive deductible on my (fairly good) health insurance are ridiculous…I paid less in the UK for an equivalent or better standard of care. My husband and I will NOT be settling permanently in the US and intend to return to Europe after I’ve finished my MSLIS here, because I refuse to live in a country where you have to choose between health care and covering other household bills. It’s appalling.

I lived and worked in the Czech Republic for four years and was on their national health insurance during that time. Since I had a baby while I was there, I would say that I got to know the system pretty well. I chose to have a private OB whom I paid out of pocket for prenatal visits and such (about $30/visit, less than most people’s co-pays in the US) but any tests that she ordered for me at local hospitals and clinics were covered in full. The endocrinologist that I saw for PCOS was covered in full, as were the meds she prescribed for me. (Name-brand, too!) When it was time to have the baby, I went to the hospital where my private doctor had privileges but ended up giving birth with the doctor on call. As per the standard protocols, I stayed five days after the birth (which was vaginal but a little complicated since my son was breech) and chose to have a private room for that stay. My son stayed most of the time in the nursery to deal with some jaundice and birth-related traumas (breech thing), so he was being cared for almost round-the-clock as well.

At the end of my stay, they gave me a hand-written bill for approximately $125 for the five-day stay in the private room. It was the only bill I ever received for my care there.

I paid more in taxes than I do now that I’m back in the States, but there is really no comparison to how much I pay out of pocket here. I had a baby here last year and have essentially had almost $10000 in out of pocket costs–that’s WITH health insurance–to try to absorb. Same kind of birth, but a less-than-two-day stay and about 4 hours of nursery care.

I also live in Japan like one of the previous posters. All people in Japan are required to have insurance. All foreigners are required to have some form of government insurance regardless of if you have private or not. It’s based on your income but also has certain charges all people must pay regardless of if you are employed or not. Looking at my layout sheet, I pay about 1 month of my salary for the year towards the health insurance (I also pay about one month of my salary for taxes). Obviously there are programs here that are similar to the US programs that are also deducted. From my layout paper I’m looking at right now, I see that I pay about 370 USD a year for “elderly assistance” so like medicare or what not. 120 USD of that is required to be paid even if one does not have any income. There is also a 250 USD fee on the insurance side of things that also is required of all adult citizens regardless of income status. …Somehow I don’t think those kinds of required fees regardless of employment status would “fly” in the USA really.

That being said, I rarely have met a Japanese or foreigner in the age range of 20-35 that actually PAYS their insurance if it’s the government kind. Most of us have low paying “temp” jobs which is why we don’t have employer insurance anyway. When one’s salary is 13 US dollars an hour and 1 apple is 3.50 USD an hour… and the cost of rent in Japan is through the roof, etc. Well then……most of us simply can’t afford it even if it is lower than certainly one would pay in the USA for health insurance. This is where i worry about the USA national plan. The people they (the government) WANT to rope into paying insurance are young, healthy people that currently choose not to have insurance for financial reasons. But yet even if this program were to be instituted, most of them still simply wouldn’t pay still. One of the problems though in the Japanese system is that it’s based on your last year’s salary total. Every year I have lived in Japan I have made less salary than the previous year so I do nothing but struggle. This used to work based on the old 1980s-90s system where one was employed by one company for the entirety of their lives and their salary would thus increase each year with seniority. But this doesn’t currently work anymore with reality, thus us young people can’t pay.

In the 3.5 years I’ve been in Japan I’ve only had about 4 run-ins with the medical establishment. I’ve never had “great” care. It has ranged from “good-ish” to “cannot believe”. One of my most positive experiences was that I ate a packet of “butter cookies” that had been made with some sort of marine based fish oil (…welcome to japan) and went into anaphylaxis and had to be taken to the hospital by ambulance and given emergency care. The ambulance ride + care + xray = about 30 USD total which is pretty unbelievable. The level of technology of care here is very much lower than what I was given in the US. The hospitals and the practices in them are very much what my mother remembers from the US 1950s. According to Japan, most of one’s ills, colds, and flu can be solved by gargling iodine. I’d worry that the level of technology of medicine the USA has now might also stagnate in the face of instituting national healthcare.

One thing I have noted is that some of the specialty “foreign language speaking” doctors and dentists in major cities (well there aren’t any in the countryside anyway) won’t accept the national health insurance. This is because what the Japanese govt things is a reasonable fee for treatment, say paying the emergency room doctor 8 USD for her entire treatment time, is pretty terrible. So private practitioners and specialty doctors sometimes refuse to take that national insurance. I worry that if the USA adopts a national system, then the public hospitals which are already pretty pinched are just going to be overcrowded more and even more hurting for staff if doctors with specialties or clout simply flee for private pastures to avoid having to take national health insurance.

For HAES topic: I’ve never NOT been told I need to lose a bit of weight by most doctors here (and every school nurse at every school I’ve worked at). The consensus is that I’m “chubby” and need to loose about 14 pounds. I’m 5 feet 10 inches tall and weigh 160 pounds.

Overall I think that the USA would benefit from national healthcare IF they made sure to tie up some of the loopholes and problems that the Japanese system has. Hopefully it will be calculated per each monthly salary instead of a year later. There won’t be required fees for the unemployed. And hopefully the government won’t try to pay the doctors peanuts forcing all the good ones to flee and making it impossible to develop new treatments.

One worry about national healthcare is that the govt itself might start going all big brother on one’s weight. The 25 year old 6 ft tall male gym teacher at my school barely has an ounce of fat yet came back “metabo” and was told to “lose weight”.

I can’t comment on Japanese health insurance in general because I was covered by the university when I was there, but I noticed the same thing in the hospitals – for such a high-technology country, it was very strange how low-tech the healthcare was.

I really want to thank you for posting this as you are using your personal experience with specific numbers. It also brings in the side of the health care professionals who are very much effected. I read in an earlier post about a doctor over prescribing pill and my first thought was the doctor was trying to make up by the shortfall in income limited by Nationalized Health Care.
I’ve also noticed a slight employee bias here. I would really like to hear something from the employer’s side. I was a little taken back by the bias in one statement:

‘Oh, and by law, the employer has to pay part of that 11%. It used to be 50/50 between employer and employee, but it’s switched a little more towards employee now (gee, thanks right-wing government…). Looking at my husband’s latest paycheck, the company is paying 47% of the cost.”

This kind of talk reeks a little too much of “Employee Good, Employer Bad” for my taste.

Anyway, I really appreciate the topic, I think we all can benefit from it. Thanks Meowser

I live in Canada and I have never had to wait for anything. I don’t have any serious diseases though. But comparing the Canadian system to the US is not valid. Canada has a population 1/10th that of the US but has a geographic area larger than US (our largest city has only a few million people). With a population so small you can’t expect to have certain specialists in every town, so you have to travel 2000 miles sometimes to see some specialists. And yes you might have to wait because there simply aren’t enough doctors around. It’s not the system that is at fault, it’s the small size of our population and huge geography. So you’re comparing apples to oranges here.

That Canadian lady who is on TV telling America about Canadian wait times paid $100,000 to have the operation she wanted. Most Canadians don’t have that kind of money lying around, and likely neither do you. So sometimes they have to wait, and sometimes they die. But if a Canadian can afford it, they can travel to the US and pay for whatever they want. And by the way, that lady still might die.

But here’s the other part of healthcare reform: It is going to cost you big bucks (there is no getting around this). In Canada a gallon of gas is always about $1.50 more than in the US. That is taxes to pay for health care. Our income taxes and sales taxes are higher than the US, primarily to pay for healthcare. The taxes on cigarettes and alcohol make them about twice as expensive as in the US, to pay for healthcare. Our military used to have a big budget before healthcare was introduced in the 1970’s, but our military has been gutted to pay for health care. Over the years, automobile daytime running lights, seatbelts, and helmets for bikers have become mandatory to reduce healthcare costs. And the constant arguing by the politicians over healthcare is endless and tired. So if you get healthcare in the US, expect taxes to go up gradually over the years and military spending to slowly go down. And expect endless, relentless political bickering. But it won’t cost you or your family $100,000 to have an operation (that might not even work).

I’d just like to point out that we pay less for healthcare than Americans do currently. Also, helmets are mandatory for children not adults. Here’s an article about debunking Canadian healthcare mythshttp://www.denverpost.com/recommended/ci_12523427

I also live in Germany like The Bald Soprano, and since she has covered the basics I want to bust some myths about government run health care.

– In Germany it is totally possible to choose your physician, and you can also get second opinions. There are very few physicians who have a private practice that doesn’t treat people on public health ensurance but they are a tiny minority. Actually, as far as I am concerned I could choose my physicians far more freely in Germany than in the US. (Things are somewhat different concerning therapists, though – there are quite a number of therapists who do not have contracts with public health insurance providers. I you are treated by one of these therapists you still can apply for coverage by through public health insurance but there is no guarantee you insurance will agree to cover treatment.)

– In general you do NOT have to wait very long for an appointment. I have never seen a family physicians that didn’t give me an appointment within two working days, even for non-emergencies. Emergencies are treated right away. There are some specialists where you will have to wait for some time for an appointment, but again this is about non-emergency care. (As before things are differen with therapists – if you want to see a therapist on your public health insurance in some areas of the country you will have to wait several months for an appointment).

– Fat people absolutely get hip and knee replacements on German public insurance. I know this is different in other countries with public health insurance – however it is not inherent in having a public system.

These are the points that come to my mind right now – I am sure there are more, and then there are of course some of the advantages of German public health insurance compared to the US system. I think the most important one is that only few people (namely the uninsured ones that The Bald Soprano mentioned) have to worry about not being able to afford live saving treatment when they get sick.

Another Aussie here…
lilacsigil and la di da have summed things up pretty well re the health system here. I live in a town of 12000 that has a large hospital and caters for a large area (outside of my town). The nearest hospital either side of my town are 45-55 minutes drive away. I have private health insurance (have for about 2 years) because I had to have surgery and didnt want to have to wait for months to have it done and also because I wanted to choose my own surgeon (something you can’t always do when you are a public patient). I have had ‘extras’ on my health insurance (and not hospital cover) for 15 years to get me rebates on my optical, dental, chiropractic and many other services. I had both my children as a public patient in a public hospital and was lucky enough to have my own OB both times. Because we are not on govt support income we pay about $32 for a prescription whereas my father who is on a disbility pension, pays about $5 each perscription. He also generally gets bulk billed when he sees the doctor (no cash out of his pocket) whereas if we go to a non bulk billing dr (which most are around here) we have to pay the fee (about $55 at my doctors) and then go to the Medicare office and get the rebate (about $28) and the remaining $22 comes out of our pocket. Once you have paid a certain amount out of your own pocket per year, you get a higher rebate from Medicare. The thought of having to pay thousands of dollars to go to the Emergency Dept boggles my mind. We go, we pay nothing unless we need meds to take home…

I’m in the US, and I just lost my job. I’ve got to use COBRA now, which is going to bite, as it’s so expensive (though Obama’s got something in place that means we won’t be paying the normal $1100/month for two). My kids will be using NJ’s Family Care.

I haven’t been able to bring myself to do more than skim through Sandy’s coverage of the Obama health care debate. I understand that she’s a libertarian in approach, but even so, it’s baffling to me to see the disconnect between her writings about fat and medicine and her writings about health care reform. It seems like an example of cognitive dissonance for the reasons you elaborate above, and I’d love to see her actually do as you’ve done here and consider both at once, and especially the ways in which private insurance is affecting the lives of poor people who are often fatter and at more risk for not having insurance at all in the present system, not to mention more likely to find it difficult to find a job with good health care coverage.

When I was working, I had insurance through work (I paid $30 a week for that) and couldn’t afford the copays to see the doctor. When I got married and quit working (didn’t want to drive 120 miles, one way), I got TriCare through my husband, who is retired from the Navy (all his care is free from the VA). Now that I’m 55 and disabled, I also have Medicare, which costs me $96 a month (comes out of my SSDI). We don’t pay any premiums for TriCare, just copays, which are 20% of what TriCare considers allowable costs (my PCP office visit is $165, TriCare allows $88.49). For TriCare, I have a $300 yearly deductible, Medicare is $135 (and the $135 for Medicare counts toward the $300 for TriCare, so I only end up paying $300 total deductible). Once the deductibles are met, Medicare is billed first, then TriCare. So far, I haven’t had to pay a copay on anything since I’ve met the deductibles, other than prescriptions ($3 for generics and $6 for name-brands).
I recently had to have an MRI to find out why I have migraine headaches, everything came to over $5,000 and I haven’t had to pay any of it (I’m not sure how much Medicare paid, but TriCare only paid about $1,000 of it, and I’m sure Medicare didn’t pay the balance, only a portion of it). So, even when you have insurance, whether it’s Medicare, TriCare, or Blue Cross, etc, none of them pay the full amount of medical charges. They pay what they deem to be a fair amount, and you pay your portion of that fair amount as copay. So doctors, hospitals, clinics, diagnostics, etc aren’t getting the full amount they charge, it’s usually anywhere from 30 to 50% (from my experience, anyway).
As far as the VA goes, my husband has type 2 diabetes, arthritis in his knees and back, and several other conditions that are service-related. He pays nothing for doctor visits, his meds are free (insulin, metformin, syringes, alcohol wipes, blood pressure med, cholesterol med, low-dose aspirin, ibuprofen), and any surgery he needs is covered (he had to have arthroscopic surgery on his left knee for problems with the meniscus and ACL). If he’s ever in an accident and has to be helicoptered anywhere, it’s covered (he’ll be stabilized at the nearest civilian hospital and then transferred to the VA hospital in Mpls, since we’re in MN). He also gets one pair of special shoes every year, free, because of his diabetes (and those shoes are not cheap). He’s also had laser eye surgery several times, and has had cataracts removed. He’s satisfied with his care at the VA, although I’ve heard other vets say they aren’t always happy with the way they’ve been treated.

I have lived in both the US and the UK. I have never had *serious* health problems, so I can’t talk about being hospitalised or the kinds of things that can leave you bankrupt. I can only talk about basic treatment and testing.

In the US, as a student, I had really good health care because my university was attached to a hospital. I could walk-in any day because I was injured or ill and get seen within an hour. I paid no extra for this, not even for prescriptions – most of the time. Except for when I had pneumonia and needed something the standard pharmacy didn’t have (They offered me a free option but because of my specifics I couldn’t take it), and then there was a lot of frantic juggling with my faraway parents to get covered, because I had no money at all and could not possibly buy the drugs I needed to breathe.

Once I was no longer a student, health care was not so simple. I had to book at least a week in advance to be seen, and copay when I got there. I needed a test at the hospital and that required *months* of waiting. Despite having insurance and paying a good bit for it, I felt it wasn’t worth trying to get seen for anything other than a chronic condition.

I’m now in the UK. The waiting times are not much different than they were in the US on insurance – but they seem a bit *shorter* to me. I’ll probably be seen within a week. I also have the option to call my GP and check for canceled appointments in order to get in more quickly. I still tend to take a ‘wait and see’ approach because I don’t want to book an appointment for something that’ll be better before I can actually get to a doctor, but I can be talked into going “just to check” on something that I don’t think is serious. I’ve been to the hospital for tests, and I pay nothing extra for that. Prescriptions, the few times I’ve needed them, are cheap. The system was also willing to take care of me when I was just a VISITOR to the country, and not waste tons of time trying to figure out how to bill me.

The NHS isn’t perfect and if you live in an understaffed area it can be stressful I’m sure, but to me it’s wonderful!

The current job I’m at now offers no health care coverage, though that may be changing later this year. So I pay for private insurance.

But because I’m fat—deathfat—the only private insurance I was eligible for is MHIP, my state’s high-risk insurance pool. When I filled out the application, I had none of the uninsurable conditions listed on the form. My only crime was being healthy but not thin enough as the other insurance companies wanted me to be. I didn’t think I would even be accepted for MHIP, but was thanks to sending them a copy of a denial letter I saved. The insurance is not cheap, but they have a special program for low-income individuals and families and I pay $160 a month. My plan is 80/20, with a $200 deductible and a drug plan (however, they are very selective about what drugs will be covered. Since I’m only taking two prescription drugs that are on the list, I’m OK). but it’s PPO and I can go to any doctor without a referral. If they’re in network, I pay 20%. Since MHIP is Blue Cross/Blue Shield, they’re accepted practically everywhere in Maryland.

I do support a government healthcare plan. Private insurance is not friendly to fatties and anyone with pre-existing conditions that need to be monitored. What I’m worried about is that here in the US, it will focus entirely on wellness and prevention programs. And as we’ve seen, these days wellness and prevention means “don’t get fat and if you are, well you better lose weight or else.” I don’t want our government singling out certain populations and making them scapegoats for medical costs, like private insurance does now.

I’ve not had issues with my Canadian coverage, but I live in a city in Ontario, and also have the benefit of belonging to a family health team. So instead of just going to see a general practitioner, the team has doctors, nurses, dieticians, therapists, and a small lab that I am able to access. This is covered by the provincial plan (OHIP), and I was so thankful that I was able to see a therapist and not have to worry about how I was going to pay for it (as I was off work on a stress leave and gettting only 55% of my salary through EI). They also have physiotherapists and chiropractors available, but these services are not covered by OHIP. The only real issue I’ve had is getting my doctor to take me seriously about my desire for an IUD, but I don’t know if that’s because of my weight or because of the fact that this birth control method isn’t widely used in North America. Because there is more than one doctor on staff, if my regular physician is booked up or on vacation, I have the option to see another person on staff. They also have some outside of office hours appointments, which are awesome because it’s difficult for me to book the time off work and travel to and from the doctor’s office adds at least 45 minutes extra time away.

The main issue is a lack of trained doctors and specialist, which can be attributed to previous governments cutting support to universities for these programs! So if you are not happy with your doctor, it is not easy to shop around for one that is a better fit, as there are not many that are accepting new patients. You will also wait to see a specialist. My city’s chamber of commerce actually spends money to recruit doctors to our area. So some people end up relying on “Urgent Care” clinics for their regular health needs.

You’ll hear a lot of people complain about wait times for care in hospitals. My advice is to take these stories with a grain of salt, as what some people think is an emergency is really not. The hospital in my city has a separate entrance bay for ambulance patients, so those walking in don’t see what all is actually happening in the emergency room. Two experiences with this, one personal, one that happened to my brother.

For me, I was exhibiting some symptoms of heart attack in women: chest pain, nausea, and sweating. Rather than take a chance, my husband and I decide to head to the emergency room. There is maybe a twenty minute wait, but once I get to see a triage nurse, that’s in, I’m admitted to the ER wing based on my symptoms. Multiple tests rule out heart attack, pulminory embolism, deep vein thrombosis (so we’re talking ultrasound and an MRI), and am given clearance to go home. There was no charge to me directly for these services. So: if you might be experiencing something serious, you do get treatment right away. If you bring yourself to the ER for a fever, expect to wait.

For my brother, he fell and fractured his skull, nonresponsive, the whole nine yards. He was airlifted to a hospital that was a 3 hour drive away because it was the nearest one that had an open nuero bed. He was in a coma, and was medically kept in it for a number of days to give his body time to react to the shock. He had xrays, MRI, and I think a CAT scan to determine the extent of his injuries. However, it was a number of days before he actually saw the nuerologist, because more severe cases of head trauma kept coming in! Wasn’t pleasant for his wife and our families while it was happening, but the fact that he wasn’t at the top of the triage meant he had better chances of recovery. After a week he was transferred to a rehab hospital here, and spent about two weeks there before he was released. Again, no charge for the hospital care, but there was a fee for the air ambulance. Thankfully he had supplementary insurance to cover that cost.

Part of the issue with our system is that I have no idea what the costs for these treatments would have been. I would almost prefer an invoice be sent to patients showing what these fees would be if they weren’t paid by the government. Some people can’t appreciate things when they don’t know the value of them.

I also have insurance through my work and through my husband’s work: this covers our prescriptions (we pay $5 per scrip), dental work, vision care, and other types of care like physio/massage therapy/chiropractor. But not all employer sponsored plans are created equal, nor are they static entities. My mom stays at her job basically to cover my dad’s medication (which costs more than her annual salary and is covered where she works – she upgraded to the best plan when that was an option and pays for that upgrade out of her paycheck). I am very thankful that I have these things available, and that I pay for these services for myself and others through my taxes. I believe that health care is a right, not a privilege, and really think that for-profit companies should not be playing a major role in the health system (and in deciding what that system should look like!).

In 2005 I applied for private health insurance and even by under-reporting my weight was denied health insurance for a “minor height/weight variation” that was the only reason listed. I was in my 20s with no pre-existing conditions and otherwise healthy. Currently I have an employer based HMO where I pay a $500 deductible, $20 co-pays and at least $15 per prescription. I also pay $70/mo towards my premium (i’m not sure the percentage that my employer pays). After a foot injury and getting my wisdom teeth removed last year (not at all covered by my dental insurance) and some visits for my PCOS I paid well over $3000 out of pocket, this is on a salary of less than $30,000/yr. I’m thankful every day that I don’t have a serious medical condition or a pregnancy as I know it would bankrupt me, and as much as I hate my insurance and job, from what I can tell I have pretty typical coverage. I’m desperate for a public option, I’ll pay more taxes if it means I can actually go to a doctor and buy food in the same week. I know that I self-ration care now, because I often can’t afford the out of pocket expenses for treatment, and am currently paying several past due medical bills.

Hi, Meowser. I enjoyed your post, and thanks for linking to my blog – there are twomore posts on the surgery topic now, and I’m planning to post more on the health care debate. I’m with you on Sandy’s views – I have nothing but respect for her, but I disagree with her on this issue.

I’m a dual American-Canadian citizen. I grew up in the US, then moved to Canada as a young adult, where I’ve lived for over ten years now. So I’ve had experiences with both healthcare systems, though not for any major issues or procedures.

In the US, during the time I briefly lived on my own as a legal adult, I never went to the doctor, period. I worked a minimum-wage job in retail and had no insurance. Going to the doctor was entirely out of the question. I worked as many hours as possible so I could make my rent and feed myself. I was horribly poor, but iirc, my income was still considered too high to qualify me for the free Oregon Health Plan or whatever. I don’t know if their requirements are now different.

At any rate, when I came to Canada, I lived without universal healthcare for over a year until my immigration was complete. During that time, I did end up going to a family doctor several times, and I paid out of pocket. Even though nothing was covered, it was insanely reasonable — like $20 or something per visit.

When I got married in Canada, my family came for the wedding, and my mom had a gallbladder attack while they were in Canada. She ended up in a Canadian emergency room. Of course, she had no coverage for Canada and paid the bill out-of-pocket. She said the hospital was great and she was stunned at how cheap the bill was when she got home (and she’s worked in the US at a hospital as a nurse for like 30 years now, so she knows what from what.)

After getting my Ontario Health Insurance Plan coverage, I’ve found myself accessing the system for several things I needed: psychiatric care, minor physical complaints, and one emergency room trip. I’ve only paid minor fees for things like doctor’s notes ($10 a pop), and for my prescriptions (thankfully, I also have group insurance through university that pays the bulk of prescriptions.)

I once tried to apply for private, complementary health insurance when I didn’t have my school’s insurance, and I was denied. I don’t know for sure why, but it was either because I’m fat or because I wear contacts or because I take antidepressants — none of which are incredibly burdensome and/or uncommon things. I was quite pissed about that, although I was given the option to pay some obscene amount of money for a worse plan. I opted not to.

In my experience, knowing that I can go to the ER, to an urgent care clinic, or to my family doctor ANYTIME without charge is extremely important. I find myself (as a person who has always been REALLY reluctant to go to the doctor for any reason) taking care of small problems before they become worse. And if my family doctor refers me to a specialist, it might take a few weeks to get an appointment, but when I do go, that is covered by OHIP too. It’s wonderful.

My experiences have been good, so far. Much better than my experience in the States, which was basically — don’t go to the doctor, ever. Even when I was a minor, and covered under my mom’s really comprehensive healthcare plan through the hospital, I remember there being a lot of insurance rigamarole to go through to get me treatment for certain things, and always, always copays for every single appointment.

I know I will likely deal with health issues in the future as I get older, and I can only hope the healthcare system continues to come through for me as it has thus far. I know there are always horror stories and mistakes that happen under any system, but I just don’t think a profit motive can be reasonably combined with something that I see as an essential service and, what’s more, a human right.

As far as being fat goes: it doesn’t appear to have affected my care much thus far. My current family doctor seems damn near fat-accepting, though I haven’t explicitly asked her about it. I haven’t been pestered to lose weight by any practitioners — but then, as I said, I haven’t had a lot of physical health problems to deal with.

I am thankful every single day for our universal health care system. As a self-employed person with several “pre-existing conditions” (osetoarthritis, two bouts of hyperthyroidism), as you so quaintly say in the States, I would be uninsurable. Instead of earning a very decent living, I could conceivably be out on the streets if I lived in the US. I would certainly never have been able to practice my profession, which is almost entirely populated by freelancers, if I lived in the States.

I have a wonderful GP, who has never quibbled about my weight (it’s been up and down) and orders all the tests she deems necessary. Lots of people complain about the time it takes to get an MRI or a CT scan. I have found that if you’re flexible, these tests can be done very quickly (the machines run 24 hr. /day so I’ve gone to hospital at 1 a.m. and been in and out lickety-split).

I did wait a long time for my hip replacement, but that was because I wanted a specific surgeon who was very well-known. The irony is that the operation went wrong and I had to go back and have it re-done. The second time around, the surgeon had me back in the operating room ASAP. He apologized profusely for what had happened and by golly, he made it better. We are much less prone to sue in Canada–this can sometimes backfire on a patient, but certainly in my case, it made the doc less afraid of a big lawsuit and much more willing to admit his mistake and fix it.

My husband works for a university and has fantastic supplementary insurance. Our dental care, drugs, physiotherapy are practically 100% covered. I am very lucky.

When Americans talk about how much their taxes will go up to pay for universal health care, all I can say is just wait until your first major illness–and most people will have some major stuff to deal with one day. That savings of a few thousand dollars a year in taxes will go up in smoke in a couple of days. And doesn’t anybody think about the thousands of dollars spent every year in premiums? I’d rather pay higher taxes and get taken care of when I’m sick rather than having an insurance company bicker with the doctors over the right treatment. I think there’s a heck of a lot more bickering in the US than you’d ever see in Canada.

No, our system’s not perfect, but I’d never trade it for the US system. Never.

Rachel, I just found your post in spam, where it wound up because of multiple links. I’m leaving it there because I really do not want Sandy and whatever past associations she may have had to be the issue here. As far as anyone knows, JFS receives no corporate funding and never has. (And anyone who writes for advertiser-supported media of any kind could easily have a similar set of issues.) It’s nothing personal, I just really do not want to go there.

I’m really happy about the level of discourse and the detailed responses here so far! You guys are great!

As far as anyone knows, JFS receives no corporate funding and never has.

And that’s the point… no one really knows. Sandy had every opportunity to clear this up in our email exchange last year and she chose not to. Until she does, I will continue to read her posts with as wary of an eye as I apply to the organizations she critiques.

My US experiences in healthcare have been good but I also know I’ve been lucky.

1) My parents were in the Teamsters Union, which meant I had the Teamsters negotiating the health insurance I enjoyed as a child and in college. The fact that I had full coverage with no copays through age 25 just because I was going to school is an incredible luxury.

2) My first job out of college was at Microsoft, which self-insures. I quickly learned not to say I had Premera (who administered the plan) but to say I had Microsoft coverage. From 90-2000 I had no copays on doctor visits. No copays on prescriptions, even antidepressants. Copays at the dentists’, but even so, my crowns and bite guard were 80% covered.

3) When I quit working for Microsoft, I could afford the COBRA, and used it for the full 18 months.

4) When that ran out, I applied for – and got – individual coverage. How? In my state, if you already have coverage, they don’t even ask your weight for individual coverage – and I applied before my COBRA ran out, and sent along the paperwork showing I’d been continuously covered. I also didn’t get the cheapest plan.

5) My later employers have offered health insurance. This is NOT Microsoft coverage, but it’s better than a lot of people in the US get.

What’s the common denominator here? Money. First my parents’ employer, then my employer, and then I have paid for the good coverage I’ve enjoyed.

What sort of plan would I like? Canada’s. Most doctors are self-employed or work at small clinics, but because it’s a single-payer system, the country as a whole spends half what we do. And while I agree with Ken that there are drawbacks to the Canadian system (that may or may not apply here) I’d switch in a heartbeat.

Yes, I looked at Medicaid once (because I have a friend who has practically no income) and was surprised to discover it does NOTHING AT ALL if you’re a single, non-disabled adult without children… even if you have an income of $0!

Pharma research, it seems to me, would have just as much funding if we continued to fund it but eliminated the massive profits that insurance companies are making. Those sure as heck aren’t all going into pharmaceutical research.

I’m English and a full time carer, so I have extensive experience of the NHS. In many ways it’s amazing, but England is a very class bound society, still, and so one’s healthcare can vary widely according to one’s social class, ethnicity, identity etc (presumably this is the same in the US but it’s demarked by how good your insurance is).

To compare, my mother recently died of lung cancer. She was cared for wonderfully well over the 14 months of her illness. She mostly chose to stay at home, and was supported in her choices at every stage. She underwent a range of radiotherapies and chemotherapies, participated in several trials of new medicines, and was not pressured into/out of any treatments. She was provided with three kinds of oxygen, a wheelchair, high armchair, shower chair, hospital bed with dynamic pressure mattress, all her medication, weekly home visits from her GP, district nursing visitors, cancer specialist nurses, physiotherapy, and as she entered the dying phase, my father was supported with home nursing care including night sitters, personal nursing care, and moving and handling equipment and training. She could have also chosen to go to a hospice. When she spent time in Christies, the staff were wonderful–efficient, competent, hygienic and friendly–and the hospital itself is a pleasant, welcoming environment with free wireless, good coffee, arts and music areas, and a mobile salon. Everything was completely free, except the coffee, and my father did not have to worry about anything other than his wife.

So that’s a white middle class Serious Illness experience of the NHS. It’s pretty great, isn’t it? But my partner is (also white) working class and has a congenital disability (spina bifida), and his experience is very different. We have had to fight for every bit of support, and he still only receives 1/8th of the home care he is allotted. He’s frequently accused of drug seeking, lying, and general moral delinquency. It took five years to get a wheelchair, even though he’s entitled to one by law. He’s been refused treatment on countless occasions because of non-attendance, and it’s been impossible to get anyone to understand that he’s not attended the hospital because he cannot walk. He’s had MRSA six times from the same inner city hospital. Every time he needs help, the entire system engages in an extended session of blame-placing, where the aim is never to solve the problem, but to place the blame back on him. There is a strong thread of blame and shame. He’s constantly being pressured to go into an old people’s home (he’s 31) or similar institution and it’s only my blatant exploitation of my own (higher) class that’s kept him from being essentially locked in a room to rot. Complaints are ignored or come back to punish you. The only way to escape this situation is to move out of this neighbourhood (one of the most deprived boroughs in the country), which we were about to do when my mum got ill.

Despite all this, it’s still better than the experience of my friend in the States who is also a full time carer, but lives in the most grinding, anxiety-ridden poverty. Our taxes, rent and bills are paid by the state (in the form of an extremely complex series of disability and low income benefits and exemptions), and all treatment, equipment, and medication is free, so we essentially live in a post-cash state (I have no money, but have few expenses). I never worry about food, heating, or clothing, and that’s what I need to survive. Fundamentally, what universal healthcare and a connected welfare state give you is a safety net. You can’t live the high life, but you can live; whatever happens, we are all fed, clothed, and housed, and…er…healthed. *g* That’s the minimum definition of society, as I understand it.

Er, I would like to clarify that of course people do end up homeless or hungry, and some people don’t have my ability to read, write etc to access the services they are entitled to. I did not mean to suggest that never happens and I’m sorry for my descent into Eurosmuggery. :/ Of course it happens! The point I was attempting to make in the last part of my comment was not that those things never happen, but that we don’t collectively accept it as a mainstream life experience or aspect of our society, as my USn friends seem resigned to.

My experience of the Canadian health care system was that in larger cities (Ottawa, Vancouver), I had absolutely no trouble getting good health care at any clinic I walked into. I was a student with almost no income for some of the time I spent in large cities, and it was wonderful to be able to get my damned bronchitis meds or whatever right away, without much cost. When I lived in smaller communities, I had no trouble getting a GP, but specialists were another story. The population simply didn’t support having an endocrinologist or a cardiologist, but the doctors did their best and would often work with specialists remotely. For example, when my dad had heart issues, they emailed his various results back and forth between our tiny town and a cardiology center in Vancouver. He was also flown out for workups once a year – no charge.

I live in a fairly large city in the U.S. now, but find it difficult to get specialists simply because my employer keeps switching our health care coverage to save costs. I just got a new job where the actual doctor I like will once again be covered, so next year’s checkup shouldn’t cost me anything. The one I just had, however, will cost me $300 – not including the $40 co-pay.

I hate the American system. People like Sandy talk about consumers being “smart enough” to take charge of their health care. Sorry, I don’t buy it. I’m an intelligent person in that I learn new things fairly easily and am good at my job. I’m not an insurance lawyer or a health care specialist which means that I am hopelessly outgunned by a health care system designed to screw me into the ground. Being fat, I’m uninsurable, so even if I did understand all the intricacies of the health care “system”, I still wouldn’t be entitled to coverage.

As for the U.S. benefiting the whole world with pharma research? It’s not about altruism, it’s about profit. That’s why we have a million bogus “treatments” for weight loss, but tend to “manage” rather than cure diseases. There’s no profit in cure.

This has happened to us – the healthcare switch every year as our employers chase cheaper options and/or we switch jobs. I think my partner’s had a different insurance company 6 times in the last 8 years.

It’s terrible. I haven’t had a regular doctor since i left my job that had the good HMO. I keep missing my yearly pap smear because finding a doctor who takes new patients is such a chore.

And there have definitely, definitely been times when our kid was sick and we waited until Monday morning instead of paying the $200 or $500 emergency room copay. Luckily, we have the money so if we really thought he needed it we could go – but those copays are a deterrent, as they’re designed to be.

I wonder if the generational difference i see on this issue, with older people who are more settled in their careers thinking things are just fine, and younger or poorer people feeling like we need a change – is partly because of the way older, middle-class people tend to not switch jobs as often.

I wonder if the generational difference i see on this issue, with older people who are more settled in their careers thinking things are just fine, and younger or poorer people feeling like we need a change

I’m middle-aged and health care is a huge issue for me because I have PCOS which puts me at risk for things I never thought about in my 20s, and I require more routine tests now than I did in college. (Back then, I only went to the doctor for my annual bouts of bronchitis.) I had the same job for six years and we changed health insurance four times. It was so confusing! Different co-pays, different benefits. Sometimes physio was covered, sometimes not.

I just don’t think that being responsible for one’s own health should necessitate outsmarting the Health Insurance Industry. It’s just not fair.

Outside the fatosphere, the Americans I see most opposed to change are either older men in established careers, or young, relatively wealthy people of college age. They’re disproportionately represented on the internet, of course, but they also seem to be generally healthy, have little experience of family illness (which is probably why they’re still middle class and above!) and currently have their healthcare looked after by their colleges and/or parents. With no personal experience, they assume that everyone is in the same position as they are, no-one is discriminated against, and, while they will acknowledge that the US system doesn’t work well for very poor people, they don’t think many people are poor, or will be made poor by the healthcare system itself.

I live, and have always lived, in the UK. Although people here are always complaining about the NHS my own experiences with it have generally been favourable enough: the only time I experienced a long waiting list was for (non-urgent, but non-cosmetic) dental surgery, the primary reason for which was individual error on the part of my dentist (the receptionist misplaced the files they were supposed to send on, so I wasn’t put on the list for several months, during which my abcess kept getting re-infected). Prescriptions here are either free (the contraceptive pill is always free, and those on benefits get everything free, I believe) or at a reasonably low cost (about £7). Dental care is a bit dicier, since finding NHS dental practices with vacancies is becoming quite difficult due to more people going private, and unless you are on benefits you do need to pay for check ups etc, although the cost for basic procedures isn’t what I would call prohibitive (I think cosmetic procedures tend not to be covered and are thus a bit pricier, hence Brits’ reputation for ‘bad’ – i.e. unattractive, but usually reasonably healthy – teeth). While most people here acknowledge that there are problems with the NHS I think very few would swap it for the US system, and the wealthy and dissatisfied can opt out anyway by purchasing private insurance like BUPA. While I am not fat now I have been in the past and never felt it prejudiced my treatment by doctors (in fact, whenever I raised my concerns about my weight nurses in particular tended to be very reassuring, attributing it to puppy fat before a growth spurt, nothing to worry about etc), however, even when I was at my biggest I was an ‘inbetweenie’ and was also under 18, so they might have been nicer to me than they would to a larger person or an adult.

I had Medicaid when I gave birth to my daughter, it wasn’t too bad but my epidural and post-natal treatment wasn’t covered so I paid out of pocket for those. Now I’m paying for private health insurance for both me and my daughter. That was a fun bit to get approved for a plan. I’ve got history of mental illnesses, hospitalizations for those mental illnesses, the dreaded FaT!!111!1!! and a wonky reproductive system. I suppose if I was healthy then health care would be cheap but alas, my body does it’s own thing.

I’m from Canada (like some of the other commenters). I don’t know if things are different depending on the province but I’ll explain how healthcare in Ontario has worked for me.

I’m still a university student (grad student) so I’ve never had to actually pay taxes at the end of the year (and I get GST cheques every year and such) but I do pay some taxes throughout the year such as sales taxes.

I’m currently covered both under a student plan (for health), a union plan (for dental) and my father’s work plan (I believe it’s pretty good b/c it’s a university plan but I can’t compare to other ones really) because I’m in school and under the age of 25. I could have opted out of the union and student plans with proof that I was covered under my Dad’s but the total refund is about $200 and my Dad’s plan has recently been changed to be significantly worse (and I’ve been dealing with long-term health issues). I never had to fill out any forms or do any tests to be covered by these plans. These plans cover pretty much everything that OHIP doesn’t (although my plans force me to pay anywhere from 20-40% of some visits). This includes things like dentistry, glasses, sports braces, casts, cruthches, physiotherapy, massage therapy, and chiropractics.

I have spent a lot of time using healthcare (more than most people my age) because I have hyper mobility in most of my joints. This would be fine if I didn’t live an active, prone to injury lifestyle. This has lead to two seperate surgeries, a fair number of broken bones and other general abnormalities. With all these issues, I have had to pay for crutches ($30), an aircast ($200), a fibreglass cast ($50), fair number of braces (all less than $100 each) and physio and chiro appt ($40 and $20 respectively). All this stuff has been covered to some degree under supplementary health plans, although physio is the worst covered.

In terms of wait times, for most tests and such, the wait time has been minimal for me (at most a month) particularly because I was willing to go in at odd hours or outside of the city I actually live in.

To see specialists, the time varies depending on the specialist. We have a limited number of surgeons who specialize in ankles so I waited about 3 months to see one and about 5 months to have surgery after seeing him. It’s important to note that while my ankle was interfering with my lifestyle, it wasn’t interfering with my ability to live (I just had to keep going to physio every week so I could calm it down).

When I’ve had to go to a dermatologist or OB/GYN the wait time was less than a month. When I had surgery on my wrist, although it took a long time to figure out what was actually wrong with it, the surgery came pretty quickly afterwards.

The biggest annoyance to me about OHIP is that it doesn’t cover birth control pills. But overall, I find it to be very friendly. I have never needed to think economically about going to the doctor or emerg.

I should also add that I’ve only had two doctors that seemed remotely concerned about my weight (although one was a real douche) and I’ve never had a doctor actually bring up my BMI (which is in the obese range) in relation to any of my problems (a lot of them involving joints which I think is classic bring up BMI territory).

Ooh, also, when trying to figure out what was wrong with my ankle I actually did get a second opinion and went with the second opinion and it wasn’t a problem at all. I was lucky because I could go to a different city (my parents’). It probably would have been harder had I been stuck in the city that I live in. I ended up going to a different primary doctor to get the referral to see the second surgeon and it may have been more difficult had I gone back to the original doctor asking for a referral to a different surgeon. It seems that a lot of cities only have one doctor that deals with ankles and most primary doctors don’t really have contacts outside of their own city to get the ball rolling.

I’m an American who emigrated to New Zealand. I had varying doctor attitudes in the US that generally ranged from well meaning but benignly useless, to openly hostile in relation to my being overweight. With medical insurance in the US I had doctors refuse to diagnose and treat me for PCOS because I was overweight (at one point I had been diagnosed, I moved and had to find a new doctor who refused to deal with me as I was ‘just fat’).

Since being in New Zealand I have dealt with my regular doctor who aided me in weight loss for immigration purposes (immigration has a BMI limit). She referred me to a nutritionist (who was the biggest jerk- he automatically assumed I ate too much and was basically a walking-talking ad for bran cereal) and suggested other methods of support. When I had asked my US doctor for help with weight issues he didn’t have any ideas other than to try getting more exercise. He wasn’t hostile though so I kept him around.
I have also dealt with an associate of my NZ doctor who gave me a lecture on needing to lose weight when seeing me for something unrelated (my doctor knows I have already lost 45kg/100lb so doesn’t badger me).

In terms of coverage I expect the system here is much like Australia as outlined above. Though NZ also has the ACC- a coverage for all accident/work injury that is separately funded (via similar methods of taxation and car registration etc). All people with a 2+ year work permit or permanent residence are covered by basic health care and there is also the option to buy insurance for faster private care from specialists.

There is some evidence of fat discrimination for things like fertility treatment for women. They want your BMI to be under a certain amount before you are eligible for publicly funded treatment. I don’t find that too heinous personally, and makes medical sense IMO.

Though NZ also has the ACC- a coverage for all accident/work injury that is separately funded

We have that too – the TAC for road accidents and Workcover for workplace accidents. It covers extra cost beyond what Medicare pays, including extra rehab/counsellors/home renovation etc. though they tend to be mean and bureaucratically slow about it. It’s covered through tax on car registration (TAC) and payroll (Workcover).

We don’t have BMI requirements for publically funded fertility treatment, which seems rather random and cruel to women who are infertile due to PCOS or certain cancers.

I’ve got PCOS and my treatment on the NHS was terrible. The head of the clinic where I got pregnant said that BMI matters NOT ONE WHIT when it comes to IVF. There may be underlying issues, such as PCOS or endo, but in general, BMI doesn’t matter.

There is some evidence of fat discrimination for things like fertility treatment for women. They want your BMI to be under a certain amount before you are eligible for publicly funded treatment. I don’t find that too heinous personally, and makes medical sense IMO.

How does it make medical sense? Are you figuring that pregnancy is dangerous for fat women? Or that our hormone levels are already screwed up? (Mine certainly are, but they were when I was much thinner, too, because of PCOS.)

Generally that regular ovulation can be effected by body weight in otherwise healthy people (absent symptoms of PCOS or other conditions as you noted).
I assumed (probably wrong of me) that the statement of guidelines (from one private clinic. Sorry I didn’t make that clear, there appears, afaik to be no such limit for general public funding) for publicly funded treatment would want to rule out issues (like weight) that they would have less control over before spending money on fertility treatment.

Some private clinics for a range of health conditions (not weight related) do publicly funded work based on other health criteria. I’d guess it’s mainly so the private clinics can maintain faster service times while providing more specialist services in areas where public services are limited.

The treatment is still available to private payers at that clinic as far as I can tell, though I don’t know about other sources of public funding in my particular area (mainly because there isn’t much online information).

I received Medicaid when I was pregnant with my daughter, and we’ve been on & off of it (mostly on) ever since. (She’s now 12.) The main reason is that I’ve had an almost-impossible time finding full-time work with full benefits. (I’m sure teh fat plays a big role in that, especially now that I’m over 40.)

I did turn down one full-time job that offered, instead of traditional health insurance, a “wellness program.” Routine doctor visits were covered, with low co-pays on prescriptions like birth control and antibiotics, but you’d better not get cancer, have a heart attack, or need surgery. If you did, you’d be on your own after the “wellness program” kicked in a couple grand.

I haven’t had much to complain about regarding the care we’ve received from Medicaid. The family practice clinic that I’ve been going to for 13 years is staffed by residents. So we get a new doctor every year or two, but there’s still a reasonable continuity of care. I’ve had some problems with Medicaid red tape, especially involving which prescriptions they will and won’t cover. But it’s nothing I haven’t heard from friends with private insurance.

My only real complaint about Medicaid is the poverty that I’m required to live in in order to remain eligible. For my state, my income is capped at about $490 per month for my little family of 2. (We live with my parents – now just my mom – the only way we could survive.) Child support, when paid regularly and in full, knocks us out of eligibility, but that almost never happens, so it’s been a cat n’ mouse game for years. (He’s about 6K in arrears right now.) When there were long stretches without child support, I’d get a part-time job – but I had to be careful never to earn over that magic number or risk losing my health coverage. (And don’t get me started on all the paperwork involved in notifying Medicaid of my employment – my bosses knew all my business because they had a zillion forms to fill out and sign regarding my income. Oh, and if they were late or lazy about getting the paperwork done, I’d be threatened with having my Medicaid cut off for “non-compliance.”)

I wish I could find a suitable full-time job with benefits. Barring that, experience tells me that people are willing to hire me part-time if they don’t have to worry about their company providing my health coverage. But if taking one of those jobs means I lose the coverage I’ve already got, but still don’t earn enough to replace it (much less enough to live on) how does that benefit me? Just what the hell am I supposed to do?

I’m a Canadian, but I’m out in the Maritime provinces. New Brunswick, to be specific. It’s very rural out here, with the big hospitals and the specialists focused around the major cities in the south of the province. I grew up in the north, though. You could go to your family doctor to get the basics looked at, and the ER if you broke a bone or whatnot, but anything the least bit complex would see you getting a specialists appointment down in Moncton or Saint John a month or two down the road. I have vivid memories of my mom discussing friends of hers and “oh yes, so and so is going to the city next month, to have her thing looked at…” My parents both had good jobs with insurance, and everything conceivable was covered. Like my epic orthodontic work and our glasses. If one of us got sick or had an accident, there was care to be had. My mother had back surgery and I remember her having to go to the city to have it, but it seemed that something covered her transportation via ambulance… I’m going to have to ask her about it.

I’m a single adult now, living in the south of the province. If I’m sick I can hit the “after hours” urgent care clinic and see a doctor, and not pay anything. If I’m really in need, I can go to the ER and get help based on how severe my condition is. (Throat infection? be prepared to camp out for a long while. Wacky medication allergic reaction? I got seen in half an hour.) Prescriptions aren’t covered, but my job offers health insurance that takes the bite out of any pills I may happen to need. I’ve never paid more than $5-$20 for a prescription, but I’m a fairly healthy young woman. My work also covers glasses and some dental. Good insurance through your job is still an incentive, because the visit may be covered but the pills and props afterwards aren’t.

My one problem now is finding myself a regular GP. There’s a doctor shortage in the city and I’m still on a waiting list. I’ve got some issues I’d like to get looked at (nothing life threatening, just obnoxious), and the urgent care clinic is not the least bit interested in dealing with them. Overall, I’m happy with the care that I receive. I have dear friends in the US that just.. sit around and pray an infection or problem doesn’t get worse, because an ER visit would be the end of them. Which is freakin’ criminal.

I just thought you’d all like to know a little more about the Canadian woman with the brain cyst. Quoting from a story by Julie Mason in the Ottawa Citizen, July 12, 2009, “There’s no doubt Holmes had a problem that needed treatment, and she was given appointments with the appropriate specialists in Ontario. She chose not to wait the few months to see them. But it’s a far cry from the life-or-death picture portrayed by Holmes on the TV ads or by McConnell in his attacks.”

I lived in the UK and was on a waiting list for IVF for 4 years. We were kicked off because I’m fat (after being told for 4 years that it wasn’t going to be a problem). My infertility treatment on the NHS was appalling and abysmal. There’s nothing like having your doctor call you at work – where 4 of your 5 other coworkers are pregnant – to tell you that you’re fucked. My husband decided he wanted to emigrate because he felt we would never be able to have children there either through IVF or adoption, and three years ago we made the move.

Today, after paying $11K, we are the proud parents of a lovely 17 month old boy, born after our 1st round of IVF (and our only infertility treatment). We hope to go back to our clinic this year to try for #2.

I’m still very bitter about the NHS and infertility, but for everything else it was fine. Then again, I’m a very healthy person, and rarely had to go to my GP.

I’m from the Netherlands and our Health Care used to be much like the one in Germany, until a recent reform. This reform was heckled and criticised by many, who said it would create “American circomstances” (by which they meant that poor people wouldn’t be able to go to the doctor), but so far it’s not as bad as that.

Everyone has to buy “basic insurance”, this is mandatory and if you don’t have the basic insurance, it’s almost like being an illegal alien; you can’t get a job, or a loan, or a house. Different insurance companies all offer the “basic insurance” and they try to be competitive by offering different extras for different prices, but the “basic insurance” is always the same. It covers going to a doctor, birth control and various other medications, dentistry, therapy (both physical and mental) and hospitalisation up to a certain point.

Extras are usually alternative therapy, like chiropractors, homeopathy and acupuncture and procedures that are not “necessary” like most plastic surgery, some forms of dentistry, etc.

This system means that your health care is not dependant on your employer, but I’m not sure whether employers help us pay for our health care insurance… I’m sorry.

I do know that insurance companies are allowed to make the extras more expensive for people who have “hig risk factors” like people with heart diseases, people who have had cancer or who are sero-positive, and yes obese people too. The theory is that the competitive market will make sure that these things will never get too expensive and will always be available to everyone. But in practise it means that some people have a lot of trouble getting insured for the care they need (like my father who has survived a heart-attach and has to continue his life on just oe coronary artery).

Another thing that’s not so good about this system, is that everyone pays roughly the same price for health care. Rich people pay the same amount of money as poor people do. Now this is a new thing in our country; we used to have a social system where the rich people had to pay for insurance, while everyone with an average income or lower got government insurance. Though this new system is more equal, it feels wrong somehow to me.

I’m afraid I can’t comment on US healthcare, having not experienced it myself, but I would like to mention the more significant incidents in my life where I have needed healthcare.

I used to get really bad tonsilitis as a child. I’m talking hallucinations, high fever, delirium and severe pain and swelling. When I had my tonsils out they struggled to stop the bleeding and I almost died, also coming too earlier than I should have after the op. Due to this I stayed in hospital longer than I otherwise would have. I had all my meals, a bed, my surgery and after-care treatment for free.

I got blood poisoning 3 times within a year when I was 15, and the third time it spread across half my face, threatening to invade my brain and eyes. I was taken for emergency hospital treatment, was on a drip for a week in hospital and then for a further 2 weeks a nurse would come to my house twice a day to top up my antibiotic IV and check on my recovery. Again, all 100% free.

When I injured my back a couple of years back, I got pretty substandard care from my GP (NHS) – the diagnosis was “back injury dueto being too fat” and my explanation of the weight-lifting I had been doing was summarily ignored. However, I was signed off of work by my doctor for 2 weeks, which meant my employer had to pay me while I was off for that period, received a recommendation of several different options for pain management and reduction of swollen muscles and was put on a waiting list for physiotherapy. I was told to use ibuprofen for reducing swelling but that, due to my pain levels, it was okay to also take a paracetemol/codeine blend. Over the 2 weeks I was off I probably spent around £3.50 on pills, and that was going through a pack of each a week. My physio appointment didn’t happen until the end of my time off, but that was probably a good thing since it took until almost that long for me to be able to walk up the street to the walk-in clinic where it was provided. My physio was great – found the muscles I had torn through weightlifting, rapidly smooshed them enough I regained almost all movement and taught me some stretches for prior and after exercise, and for whenever I got stiff, to prevent the same injury happening again. The only thing I paid for was my tablets.

My contraception has until now been 100% free. Anyone under 25 can walk into a family planning centre and walk out with a bag of condoms, or can arrange to go on the pill, or implanon, or the coil, and does not pay a penny. I am on my third replacement implanon, which is perfect for me since I am too forgetfulfor daily pills and my OH and I cant use condoms.

The main issue for me is that dental care on the NHS is almost impossible to get – NHS dentists are few and far between and are usually heavily oversubscribed. Since most people can’t afford the cost of private dental care, like myself, that means going without. I haven’t seen a dentist since I was 13 and my teeth are pretty bad.

But, for around 6.5% ish of my monthly income and no additional amounts to pay unless I go in for something elective, like plastic surgery, or the nominal costs of pills, I’m satisfied. Total income tax in the UK (including NI contributions) is 20% for people earning under £36K a year. I don’t know what the US tax brackets are, but £36K right now is about $58K, if that helps at all.

I was very nearly denied something on the basis of weight, in a place where virtually everyone but me, is denied it on the basis of weight. The only reason I got the healthcare I needed was… well it’s a bit of a long story.

So I badly needed a breast reduction. As in, my neck was on fire 24/7 to the point of needing frequent nerve blocks to even slightly dull the intensity of the pain. (I still get the nerve blocks, but instead of just knocking it down a notch they now knock it down to barely anything a lot of the time.) My skin is thin on a lot of parts of my body, and my breasts were so big that they were ripping the skin open just by their weight. I was under daily care for skin infections beneath my breasts. My breasts were even getting in the way to the point that they were driving my motorized wheelchair for me by accident, and at one point this resulted in driving my feet directly through a glass oven door. We called it ‘tit-driving’ and sometimes it got scary (like when it would result in one of my limbs being wedged into a tight space with the wheelchair pushing in on them). And that’s just the beginning, basically I met every single criteria for needing a breast reduction. (And it shouldn’t matter, but my breasts were huge even when I was relatively thin. They’re just like that.)

I went in to the clinic, and the very first thing the nurse did was pull out a BMI chart, tell me how DEATHFATS I was, and tell me to eat less and exercise more and that they simply do not give this treatment to people who cannot lose weight. Mind you, they’re not even just talking about people like me who are considered very fat. They’re talking about people who are barely over average BMI also being forced to lose weight until their BMI was under a certain exact number.

I explained to this nurse that I was incapable of exercise due to a neurologic muscle disorder that among other things causes exercise intolerance. As in, I can barely tolerate the level of exercise it takes to do various everyday things, sometimes I can’t tolerate it at all. And I certainly can’t tolerate aerobic exercise. I told her I already eat healthily, and that I can’t eat any less without it affecting my health in major ways (because without food my muscle condition gets horrendous). She got this sickeningly sweet smile and said, “Have you ever been to a dietician?” Fortunately I could answer, “As it happens, yes.” She told me lots of “inspiring” stories of people who had lost 30, 70, 100 pounds to get this surgery done. And she told me that regardless of my situation it was just not possible for me to get a breast reduction.

I wanted to cry by the time I actually got to talk to the doctor. He told me why their policy is not to do breast reductions on fat people, much of which was based in misinformation on things like anesthesiology for fat people. There are a lot of myths floating around out there. The only thing that actually sounded halfway legitimate was scar healing, and honestly that’s cosmetic and weren’t they saying I had to prove I didn’t want the surgery for cosmetic reasons, so why should I give a fuck about it leaving a scar?

I ended up basically begging and pleading with him. I told him how many different ways I needed the surgery. I told him how many different ways that even the standard amount of weight loss was impossible for me. And I told him I didn’t give a fuck what the scar looked like. I told him I didn’t even care if he just lopped off my boobs and didn’t give me nipples to make the surgery simpler. I told him I would basically consent to anything as long as he could make my boobs as small as possible, and that I wasn’t concerned with looking pretty because who’s going to see it anyway?

To make a long story short, I eventually got the surgery. But I’m telling this story because I don’t think any other fat people get this surgery there. I got really lucky in being able to basically beg my way into it by making it clear how little I cared about any of the complications, I even said I’d sign something waiving any responsibility of theirs for how things end up looking or turning out. My mother tells me that when she talked to the doctor in private, he’d told her that he basically had to pull a crapload of strings to get the surgery approved at all, because of my weight. (It also turned out that because of regulations about mastectomies, and his personal pride, he did end up making them look mostly breastlike and with nipples, even though I didn’t care one way or the other. There’s a scar but it’s not awful like they predicted, or maybe I just have an unusual standard for scars.)

So this is more a story of “They tried to deny me healthcare and I fought it and won,” rather than a story of being denied healthcare in the end. But it’s important because if I hadn’t done all that and he hadn’t been in just the right mood I would have been denied healthcare just like probably hundreds of other fat women.